I will include a brief summary of the results I have received from the Seattle Twin Study on CFS.

According to their research:

146 female twin pairs (at least one twin reported 6 months or longer of fatigue) completed questionnaire on symptoms of CFS, physical health and a psychiatric interview. Identical twins had a higher concordance rate (both twins had the same condition) than the faternal twins. The results suggests that genes (heridity) may be an important factor in the cause of CFS.

According to the Revised Ways of Coping Checklist administered to both faternal and identical twins with and without CFS revealed the pattern of coping strategies was similar for both groups. However the CFS twins used more avoidance strategies and more avoidance to problem focused coping. Both twins generally displays the same behavior patterns in coping with stress but the CFS twins used more avoidance.

According to a study of 115 twin pairs where one had CFS and the other one was healthy they found a number of conditions were higher in the fatigue twin. Fatigue twins have had a 25 times greater chance of having FM and 5 times greater chance of having irritable bowel syndrome, multiple chemical sensitivities, and temporomandibular disorder than the healthy twins.

Intensive week long study of 22 sets of twins (one meeting the 1994 CDC case definition of CFS, and the other one healthy) revealed several findings. They are still analyzing all the data but did find remarkedly disrupted sleep (alpha waves intruding in delta wave sleep), poor performance on several cognitive tests (memory) and severely impaired exercise capacity in both CFS and healthy twins. They did find some "intriguing" differences in immune function and perceptual style. As a result they will continue the study focusing on these "abnormalities" and the differences in the perception of these "abnormalities" between the two groups. (In other words why does the alpha waves keep the CFS twin from feeling they get a good night's sleep while the "healthy" twins feel they sleep sound. It should be interesting.)

The results are being published. As I get the results I will share them here.

CFS Twin Study: Phase 1 Abstracts Abstracts includes: Cellular immunity in monozygotic twins discordant for chronic fatigue syndrome. Studies elsewhere have suggested that immune dysfunction may be common in patients with chronic fatigue syndrome (CFS). The objective of this study was to assess the nature and extent of abnormalities in lymphocyte cell surface markers and NK cell activity in patients with CFS while controlling for genetic factors. Page includes increasing number of abstracts from the first CFS Twin Study, as I get them.

Chronic fatigue and anxiety/depression: a twin study Conclusions In this sample, chronic fatigue and psychological distress are strongly associated without evidence for genetic covariation, implying that the association is environmental, or due to overlapping definitions. Any genetic covariation missed is likely to involve anxiety rather than depression.

Functional Magnetic Resonance Imaging (fMRI) "Specifically, it shows which areas of the brain are active when a person thinks, speaks, moves, feels, or remembers." Site includes a lot of info on fMR & explainations. "Observing differences in blood flow between active areas and less active areas requires "seeing" very small changes (1- 4%). These small differences require that we use statistical analyses of these images to produce reliable results. The large number of images acquired during each session (500-1200 images) necessitates significant effort, manpower, hardware, software, as well as digital storage, to process and analyze these results. These tasks demand image co-registration, mathematical correction for motion and other potential artifactual errors, and require state-of-the-art knowledge to produce reliable and valid results." At Seattle they will be looking at how the twin with CFS brain reacts to various stimuli compared to the twins who are not bothered by CFS symptoms. This should be an interesting study.

PURPOSE: To describe the Chairi I Malformation in relation to the anatomy
of the brain and spinal cord, the common manifestations of the condition,
diagnostic considerations, and management for the primary care provider.

CONCLUSIONS: The adult Chairi I Malformation is an insidious congenital
brainstem anomaly that consists of caudal displacement of the cerebellar
tonsils, brainstem and fourth ventricle into the upper cervical space,
resulting in overcrowding of the posterior fossa.

IMPLICATIONS FOR PRACTICE: Due to the vague, and often ambiguous
presenting symptoms of Chiari I Malformation, many patients are
misdiagnosed with conditions such as multiple sclerosis, fibromyalgia,
chronic fatigue syndrome, or psychiatric disorders. Patients frequently
experience symptoms months to years prior to accurate diagnosis and often
incur irreversible neurologic deficits.

National Fibromyalgia Research Association (NFRA) Funding Pilot Study on Spinal Cord Compression Dr. Michael Rosner's findings are prompting other researchers to explore the possibility of Chairi I Malformation. NFRA is funding research by Dr. Robert Bennett of Oregon Health Sciences University, Dr. I. Jon Russell of the University of Texas Health Sciences at San Antonio, and Dr. Dan Clauw of Georgetown University. However researchers are also doing MRIs of all the twins in phase 2 to see if Chairi I Malformation is present in the twins with CFS/FM as well as comparing results to the healthy twins.

The Chiari I Malformation: 1998 Experience Evaluation: MRI: MRI is the diagnostic test of choice, Crowding & tonsillar herniation, 5 mm or more herniation of the tonsils, 3-5 mm herniation -CM I if other features present

The purpose of this study was to investigate the relationship between
on-going pain and acute thermal pain in patients suffering from chronic
pain.

This experimental study in cold and heat sensitivity was performed in
order to test the following hypothesis: that fibromyalgia patients
scoring high in current background pain tolerate less experimental
thermal pain in the skin than patients with low scores. Ethical aspects
of the study are discussed.

The level of tolerable experimental thermal stimuli was tested and
compared between the 'low-score' and the 'high-score' patients.
Background pain seemed to affect the intensity of experimental cold pain.
Clinical routine examinations and bodily care of the skin that might
interfere with background pain in the fibromyalgia patients are
discussed.

Clinical practice should be carefully planned in order to assist
fibromyalgia patients in understanding and coping with thermal conditions
that might influence background pain.

Factors explaining variance in perceived pain in women with fibromyalgia.

BACKGROUND: We hypothesized that a substantial proportion of the subjectively
experienced variance in pain in fibromyalgia patients would be explained by
psychological factors alone, but that a combined model, including
neuroendocrine and autonomic factors, would give the most parsimonious
explanation of variance in pain.

METHODS: Psychometric assessment included McGill Pain Questionnaire, General
Health Questionnaire, Hospital Anxiety and Depression Rating Scale, Eysenck
personality Inventory, Neuroticism and Lie subscales, Toronto Alexithymia
Scale, and Multidimensional Health Locus of Control Scale and was performed
in 42 female patients with fibromyalgia and 48 female age matched random
sample population controls. A subgroup of the original sample (22
fibromyalgia patients and 13 controls) underwent a pharmacological challenge
test with buspirone to assess autonomic and adrenocortical reactivity to
serotonergic challenge.

RESULTS: Although fibromyalgia patients scored high on neuroticism, anxiety,
depression and general distress, only a minor part of variance in pain was
explained by psychological factors alone. High pain score was associated with
high neuroticism, low baseline cortisol level and small drop in systolic
blood pressure after buspirone challenge test. This model explained 41.5% of
total pain in fibromyalgia patients. In population controls, psychological
factors alone were significant predictors for variance in pain.

CONCLUSION: Fibromyalgia patients may have reduced reactivity in the central
sympathetic system or perturbations in the sympathetic-parasympathetic
balance. This study shows that a biopsychosocial model, including
psychological factors as well as factors related to perturbations of the
autonomic nervous system and hypothalamic-pituitary-adrenal axis, is needed
to explain perceived pain in fibromyalgia patients.

Somatosensory perception thresholds, perceived intensity, and quality of
perceptions were assessed in 20 women with fibromyalgia syndrome (FMS) and in
20 healthy age-matched female controls. All patients and controls scaled
perceived intensity and described perceived quality of randomized thermal
(Thermotest) and tactile (von Frey filaments) stimulation. Perceived
intensity was scaled by free-number magnitude estimation and interindividual
comparability was accomplished by Master Scaling. Perceived quality was
assessed by choosing verbal descriptors from a list. Thenar was used as a
reference for each modality tested. All patients were able to reliably scale
perceived intensity at thenar, as well as in pain-affected body areas.
Perception thresholds for cold pain, heat pain, cold-pain tolerance and
heat-pain tolerance were significantly lower in patients than controls. For
cold and tactile stimulation, the master scaled perceived intensities were
significantly higher in patients' pain-affected areas, whereas for
warmth/heat stimulation, the intensities were significantly lower. In the
qualitative perceptual analysis the most striking and significant finding was
the aberration of cold-evoked perceptions in all patients: most stimuli in
the range of 30-10 degrees C were reported as heat or other paresthetic or
dysesthetic perceptions. The perceptual quality of warmth, and of touch, did
not differ from the controls. Another aberration was observed in the
nociceptive range of thermal and of tactile stimulation as significantly more
frequent pain-related descriptors than in controls. This indicates a general
nociceptive facilitation in addition to the lower thermal pain thresholds.
The combination of cold hyperesthesia, cold dysesthesia, and multimodal
hyperalgesia suggests a selective pathophysiology at a particular level of
integration, possibly in the insular cortex. It is suggested that the
aberrations revealed by the supraliminal sensory evaluation may be generic
for FMS. Particularly, the aberrations established in all patients for
perceived quality and intensity in the cold sensory channel may be an
additional diagnostic criterion.

OBJECTIVE: The hallmark symptom of fibromyalgia (FM) is widespread chronic
pain, but most patients are also impaired due to fatigue and sleep
disturbance, and there is a strong association with depression. We compared
levels of activity and sleep patterns in FM patients, with and without
comorbid depression, to those of normal healthy controls and depressed
patients.

METHODS: Actigraphy was carried out on 16 patients with uncomplicated FM, 6
FM patients with comorbid depression, 9 patients with recurrent major
depression, and 28 healthy controls over a period of 5-7 days. The means of
daytime activity levels, nighttime activity levels, and percentage time spent
asleep during the daytime and nighttime were calculated and compared.

RESULTS: Controls showed high levels of activity during the day and
uninterrupted periods of sleep at night. Patients with FM alone showed
similar levels of daytime activity, but disturbed sleep with significantly
increased levels of activity at night compared to normal controls. Patients
with depression alone also showed disturbed sleep compared to normal
controls. However, patients with FM and comorbid depression showed the most
impairment, with significantly reduced daytime activity and significantly
increased daytime sleeping compared to controls, as well as more sleep
interruption and movement during the night.

CONCLUSION: Actigraphy is a useful means of studying activity levels and
sleep patterns and demonstrated significant differences between FM patients
with and without comorbid depression.

CDC CFS definition Complete Text of Revised Case Definition: The Chronic Fatigue Syndrome: A Comprehensive Approach to its Definition and Study "The complexities of the chronic fatigue syndrome and the methodologic problems associated with its study indicate the need for a comprehensive, systematic, and integrated approach to the evaluation, classification, and study of persons with this condition and other fatiguing illnesses. We propose a conceptual framework and a set of guidelines that provide such an approach. Our guidelines include recommendations for the clinical evaluation of fatigued persons, a revised case definition of the chronic fatigue syndrome, and a strategy for subgrouping fatigued persons in formal investigations. We have developed a conceptual framework and a set of research guidelines to use in studies of the chronic fatigue syndrome. The guidelines cover the clinical and laboratory evaluation of persons with unexplained fatigue; the identification of underlying conditions that may explain the presence of chronic fatigue; revised criteria for defining cases of the chronic fatigue syndrome; and a strategy for subdividing the chronic fatigue syndrome and other unexplained cases of chronic fatigue into subgroups."

Premorbid "overactive" lifestyle in chronic fatigue syndrome and fibromyalgia: An etiological factor or proof of good citizenship? This may be an influencing factor to cause increased stress which could contribute to triggering FM. Abstract
"Objective: In a former study, we have shown that patients suffering from
chronic fatigue syndrome (CFS) or chronic pain, when questioned about their
premorbid lifestyle, reported a high level of "action-proneness" as compared
to control groups. The aim of the present study was to control for the
patients' possible idealisation of their previous attitude towards action.
Methods: A validated Dutch self-report questionnaire measuring
"action-proneness" (the HAB) was completed by 62 randomly selected tertiary
care CFS and fibromyalgia (FM) patients, as well as by their significant
others (SOs). Results: HAB scores of the patients and those of the SOs were
very similar and significantly higher than the norm values. Whether or not the
SO showed sympathy for the patient's illness did not influence the results to
a great extent. SOs with a negative attitude towards the illness even
characterized the patients as more "action-prone." Conclusions: These results
provide further support for the hypothesis that a high level of
"action-proneness" may play a predisposing, initiating and/or perpetuating
role in CFS and FM."

Ladies: Keep a Watch on That Belly Shrinking the Waistline Might Save Your Life Belly fat increases heart disease risk, especially in women. "Weight gain in women, particularly in the abdominal area, triggers inflammation in the body and significantly raises your risk of heart disease, according to a new study." If it increases inflammation and FM is a type of inflammation of the muscles, then it may also influence the degree of FM symptoms. It sounds like a viable theory which I passed onto the researchers in Seattle. (hey my sister has a larger abdomin than mine (2 kids) & severe FM symptoms. However sometimes it seems mine is growing.)